If I’ve had a dose of the Oxford-AstraZeneca vaccine, what should I do?
The advice remains to get your second dose, whatever your age. If you’re under 30 and have had a jab, it means you’re at a higher risk because of a health condition, or perhaps because you work in health or social care. That means the risk/benefit balance for you is probably still in favour of taking the vaccine.
Am I at risk from a clot after the second shot?
Unlikely. There have been no reports of the type of blood clots in question after a second dose. All 79 of the thrombocytopenia cases have been after first doses. The advice from the medical regulator was that anyone who experienced cerebral or other major blood clots with low levels of platelets after their first dose should not have their second dose. Anyone who did not should come forward for their second dose when invited.
If I had another reaction to the AstraZeneca first dose should I be worried?
There is not any known link between other reactions, such as muscle aches and fatigue, and this rare complication. Experts from the Joint Committee on Vaccination and Immunisation, the independent panel that formulates government policy, have said that you should go ahead and have the second shot.
What are the risks of this in those without the vaccine?
The cause of death for most people with this vaccine-associated condition is cerebral venous sinus thrombosis, or blood clots in part of the brain. The incidence of this is rare enough that regulators complain the data is poor. In the general population, they expect between 2 and 16 cases per million people per year. It is more than twice as likely to occur in women, possibly because of the use of hormone replacement therapy and the contraceptive pill, which seems to raise the risk six-fold.
How many under-30s have been vaccinated so far?
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We don’t know exactly, although NHS England statistics show 6.3 million under-50s have so far been given at least one dose. Most of those are likely to be over 30.
Can I refuse the AstraZeneca jab?
People have not been able to choose which vaccine they will receive. This is not expected to change but those under 30 should be offered either the Moderna or Pfizer vaccines, if they are available. However, they will still have the option of taking the AstraZeneca vaccine if they want to get jabbed sooner.
Can I get a second dose of something else?
The recommendation is not to mix and match unless unavoidable. Trials are under way to see whether giving a second dose of a different vaccine makes any difference to efficacy.
What if I’m 30, aren’t I as at risk as someone who is 29 and 11 months?
In some ways age cut-offs are always going to be arbitrary. But what we do know is that the increase in risk from coronavirus itself does go up as we get older.
If this happens to me, is it treatable?
Yes, the British Society of Haematology say this is very treatable. Its guidance tells doctors to give patients as soon as possible something called intravenous immunoglobulin, effectively concentrated antibodies that block the effects of antibodies that are causing harm. That can be followed, once the patient is relatively safe and has adequate platelets, with anticoagulation drugs.
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How does this risk compare to other medicines?
A large study that looked at Danish health records found that for every 10,000 women between 15-44 years old who used the contraceptive pill, there were 4-16 cases of blood clots a year, depending on the type of pill. That compared with about 4 cases per 10,000 among women of the same age not on the pill. Other vaccines have been linked to very rare adverse effects. America’s Centre for Disease Control estimates that for every million flu shots there may be one or two additional cases of Guillain-Barré syndrome, which causes muscle weakness and sometimes paralysis. The National Blood Clot Alliance estimates that 1 in 1,000 people will naturally experience deep vein thrombosis, a dangerous form of blood clot, per year.
Can I do anything to reduce my risk? Should I maybe take blood thinners before my jab? Taking anticoagulants or drugs such as aspirin in an attempt to prevent this is not a good idea. The condition itself is associated with low platelet counts — or thinner blood — and those drugs come with their own (more common) side-effects. Beverley Hunt, professor of thrombosis and haemostasis at King’s College London, said: “We have to remember this is very, very rare. And it’s very unusual in how it’s responding, it’s an immune response from the current data. We’re developing antibodies so taking aspirin is not going to be helpful, or taking an anticoagulant probably isn’t going to be helpful, especially if you’re going to get a low platelet count, it’ll increase your risk of bleeding. And we know that if you take aspirin and you don’t need to, the benefits aren’t very good and there is a risk that you can bleed spontaneously.”
Are there any danger signs?
Dr June Raine, head of the MHRA, said that people who develop unusual bruising or a headache that persists more than a few days after vaccination should seek medical attention. However, she also asked people to remember that mild flu-like symptoms were one of the most common side-effects of any Covid-19 vaccine, including headache, chills and fever. These generally appear within a few hours and resolve within a day or two but not everyone gets them.
David Werring, professor of clinical neurology at University College London, said that prompt treatment was important. “While vaccination programs should continue, a key message is that people receiving the vaccine, their doctors, and other healthcare professionals need to be aware of the possible symptoms of thrombosis, especially in the brain,” he said.
These would include a severe headache that is sudden or progressive; neurological symptoms (for example face, arm or leg weakness, disturbance of speech or vision, confusion, drowsiness or seizures); shortness of breath; or leg pain and swelling. “Specific treatments in hospital may improve the outcome from cerebral venous sinus thrombosis — but only if given soon enough — so it is crucial that people seek medical attention urgently if they experience these symptoms between 4 and 21 days after vaccination,” Werring said.
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